Seminar 2: Admitting Mistakes: Ethical Choices and Reasoning
Goal: Residents will understand how to approach clinical situations in an ethical
manner and deal with mistakes.
Objectives: By the end of the session, the resident will:
Cognitive Objectives
1.
Apply an ethical approach when confronted with the following:
 A medical mistake
 Understanding the difference between an error and a complication
 Reporting a medical mistake to colleagues and superiors
 Reporting a medical mistake to the patient/family
 Understanding how a mistake can affect your surgical career
 Personal emotional response to a mistake she/he commits
2. Know the institutional guidelines for reporting a medical mistake
3. Understand the concept of “the standard of care”
4. Know your obligations and behavior when sued
Skills Objectives
1. Be able to present in an appropriate fashion to a patient and or family that a
mistake has been made.
2. Understand how to distinguish between an error and a complication
3. Know to whom an error or complication must be reported
SPICE
Session Outline
1. Review Goals and Objectives
2. Medical mistakes can and do happen – and you will commit a mistake on multiple
occasions during your residency and practice years. A video clip from Grey’s
Anatomy showing a surgical resident puncturing the heart with her fingernail. She
decides not to tell the senior surgeon. Discussion of “what would you do?”
Subsequent video clip shows her asking for advice from fellow resident about if she
did the right thing. She receives affirmation of her (incorrect) decision from fellow
resident. Would you give similar advice to fellow resident?
3. Define what a medical mistake is. What is the difference between a medical
complication and a medical mistake? Who is affected by a medical mistake?
4. Subsequent video clip shows patient having a delayed complication of cardiac
rupture in the ICU while family is in the room. Resident blurts out truth.
5. How should bad news (complications and mistakes) be delivered to the family?
What are required reporting requirements to those physicians senior to you? Ethical
choices in a litigious society.
6. How can you deal with your own fallibility in delivering medical care?
7. Review of Goals and Objectives.
SPICE
Relevant Literature
Chan, D. K., T. H. Gallagher, et al. (2005). "How surgeons disclose medical errors to
patients: a study using standardized patients." Surgery 138(5): 851-8.
CONCLUSIONS: The patient safety movement calls for disclosure of medical
errors, but significant gaps exist between how surgeons disclose errors and patient
preferences. Only 57% used the word mistake, 47% apologized, and 55%
validated patients’ emotions. Programs should be developed to teach surgeons
how to communicate more effectively with patients about errors.
Christensen JF. Levinson W. Dunn PM. The heart of darkness: the impact of perceived
mistakes on physicians. Journal of General Internal Medicine. 7(4):424-31, 1992 JulAug.
CONCLUSIONS: The perception of having made a mistake creates significant
emotional distress for practicing physicians and the severity of this distress may
be influenced by factors such as prior beliefs and perfectionism. From an analysis
of interviews with practicing physicians regarding mistakes themes emerged
were: the ubiquity of mistakes; the infrequency of self-disclosure about mistakes
to colleagues, family, and friends; the lack of support among colleagues; the
degree of emotional impact on the physician, so that some mistakes were
remembered in great detail even after several years; and the influence of the
physician's professional locus of control on subsequent emotions.
West, C. P., M. M. Huschka, et al. (2006). "Association of perceived medical errors with
resident distress and empathy: a prospective longitudinal study." JAMA 296(9): 1071-8.
CONCLUSIONS: Self-perceived medical errors are common among internal
medicine residents and are associated with substantial subsequent personal
distress. Personal distress and decreased empathy are also associated with
increased odds of future self-perceived errors, suggesting that perceived errors
and distress may be related in a reciprocal cycle.
SPICE